One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee's models were used to guide this project, which was comprised of 2 phases. Phase 1 included a team of 10 experts that created the needs assessment that would establish hemodynamic stability using a 4-point scale. The items for inclusion in the needs assessment included primary cesarean, repeat cesarean, no urinary tract infection present, no fetal distress present, no systemic disorders present, no hypertensive disorders present, and no contraindications for anesthesia. Phase 2 was the implementation and evaluation of the needs assessment and new practice guidelines. Statistical analysis was performed using the Mann Whitney U test. There was 98% compliance (p < 0.001.) with the use of the assessment in women undergoing a cesarean delivery and a 64% reduction in the length of time an indwelling catheter was left in place. However, there was no significant change in the number of women receiving a catheter prior to cesarean delivery after a needs assessment was performed (p = 0.805). This project has potential implications that would support social change by reducing the use of indwelling catheters among hemodynamically stable women undergoing cesarean deliveries.

The increasing rates of intervention in childbirth are an issue for women, their families, health professionals, and society across much of the Western World. This study is a response to these increasing rates of intervention, as reflected in the research question: 'What is shaping the practice of health professionals and the understanding of the public in relation to increasing intervention in childbirth?' The participants in the study were nine health professionals: midwives and obstetricians, who were interviewed individually, and thirty-three members of the public who took part in six focus groups. The research was carried out under the umbrella of critical hermeneutics, and the particular approach used was that of critical interpretation as formulated by Hans Kogler. This approach enabled a hermeneutical thematic analysis of that which is shaped (worldviews) and a critical structural analysis (discursive orders, social practices, relationships of power and structures of domination) of the shaping and shapers of practice and understanding. The research process facilitated by critical interpretation in identifying and describing the shaping and shapers of practice and understanding adds an important dimension to the statistical picture of increasing intervention that is of concern, both to health professionals and the public. The research revealed that the everyday world and its associated processes of socialisation in the 21st century - in particular pain, choice, and technology - shape the practice of health professionals and the understanding of the public in relation to increasing intervention. The study's findings were supported by the revelation that many of the social and cultural values, such as convenience, ease, and control, that underpin Western society in the 21st century, correlate with what intervention has to offer, which results in intervention being increasingly sought after and utilised. This milieu of intervention, which increasingly surrounds childbirth, is shown to be calling into question those things that have traditionally been at the heart of childbirth: the ability of the woman to birth and the clinical skills of the health professional. This research provides insight and awareness of those things that are shaping understanding and practice and birth itself and creating a milieu in which intervention is increasingly normalised.

The increasing rates of intervention in childbirth are an issue for women, their families, health professionals, and society across much of the Western World. This study is a response to these increasing rates of intervention, as reflected in the research question: 'What is shaping the practice of health professionals and the understanding of the public in relation to increasing intervention in childbirth?' The participants in the study were nine health professionals: midwives and obstetricians, who were interviewed individually, and thirty-three members of the public who took part in six focus groups. The research was carried out under the umbrella of critical hermeneutics, and the particular approach used was that of critical interpretation as formulated by Hans Kogler. This approach enabled a hermeneutical thematic analysis of that which is shaped (worldviews) and a critical structural analysis (discursive orders, social practices, relationships of power and structures of domination) of the shaping and shapers of practice and understanding. The research process facilitated by critical interpretation in identifying and describing the shaping and shapers of practice and understanding adds an important dimension to the statistical picture of increasing intervention that is of concern, both to health professionals and the public. The research revealed that the everyday world and its associated processes of socialisation in the 21st century - in particular pain, choice, and technology - shape the practice of health professionals and the understanding of the public in relation to increasing intervention. The study's findings were supported by the revelation that many of the social and cultural values, such as convenience, ease, and control, that underpin Western society in the 21st century, correlate with what intervention has to offer, which results in intervention being increasingly sought after and utilised. This milieu of intervention, which increasingly surrounds childbirth, is shown to be calling into question those things that have traditionally been at the heart of childbirth: the ability of the woman to birth and the clinical skills of the health professional. This research provides insight and awareness of those things that are shaping understanding and practice and birth itself and creating a milieu in which intervention is increasingly normalised.

This dissertation examines three health and development issues in Sub-Saharan Africa. It analyzes the impact of policy changes and interventions on child mortality, household food consumption and cesarean section births. The study is motivated by the Millennium Development Goals and policies which could affect their achievement. In the first essay, I investigate the impact of debt relief on under-five mortality rate. A dynamic panel data estimator is employed in the analysis. The result shows that debt relief is associated with a statistically significant reduction in under-five mortality rate. I conclude that conditionality of debt relief or development aid can yield positive outcomes. The second essay examines the impact of private hospitals on the likelihood of cesarean section births in Uganda. The study is motivated by the increase in cesarean section births following the proliferation of private hospitals. The main method of estimation is a bivariate probit model. The results show that delivery at private hospitals increases the probability of cesarean section births, thus there is need to monitor private hospitals so that expectant mothers are protected from physician induced demand for avoidable cesarean section births. The final essay studies the impact of agricultural extension services on household food consumption in Uganda. The study exploits the variation in participation in the NAADS to estimate the impact of the program on household food consumption. I find that NAADS membership and training are associated with an increase in household food consumption, hence agricultural extension services can be used to reduce food insecurity. Policy recommendations and future studies are explored.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2016-09-28T17:30:19Z No. of bitstreams: 1 Míriam Kênia.pdf: 3137468 bytes, checksum: 2a6d6c6a5a7a6f20c2a7cd6bf12cdaf3 (MD5) / Made available in DSpace on 2016-09-28T17:30:19Z (GMT). No. of bitstreams: 1 Míriam Kênia.pdf: 3137468 bytes, checksum: 2a6d6c6a5a7a6f20c2a7cd6bf12cdaf3 (MD5) Previous issue date: 2016-06-28 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The Research investigates the biopolitic convocations around child birth methods, C-section and normal birth, in the media, in relationship websites, social media and in the communication within the maternity centers. The speeches and narratives are built around fear and support the paradox: normal and safe to do is a C-section; strange and risky is the normal birth. This media strategy, considered a device in the Focault and Agamben concept, more than fulfill the position of spreading the word and legitimating the biopolitic speech, but is also responsible for building this model. The bio politic guidelines around childbirth are anchored in the control of the body and in bio economics, according to Nikolas Rose. By taking the woman from the scene and outsourcing the protagonist of child birth to the doctor, this assistance model makes the female body more controllable and productive. After all, the current biopolitic is focused in the increasing capacities to control, manage, plan, and remodeled the vital capacities. And how to do that? The media, with its convocations, teaches. It is also attempted to investigate, by means of Bodymedia theory, the changes in the body immersed in the C-section environment, that passes through cognitive changes and causes several other modifications in the environment / A pesquisa investiga as convocações biopolíticas em torno da via de nascimento, parto e cesariana, na imprensa, nos sites de relacionamento, nas redes sociais e na comunicação das maternidades. Os discursos e narrativas são construídos em torno do medo e sustentam o paradoxo: Normal e seguro é fazer cesariana. Estranho e arriscado é o parto. Essas mídias, consideradas dispositivos, no conceito de Foucault e Agamben, mais do que assumirem o papel de propagarem e legitimarem o discurso biopolítico em prol da cesariana, fazem parte da construção desse modelo. As diretrizes biopolíticas em torno do nascimento são ancoradas no controle do corpo e na bioeconomia, de acordo com Nikolas Rose. Ao tirar a mulher de cena e terceirizar o protagonismo do nascimento para o médico, esse modelo de assistência tonar o corpo feminino mais controlado e produtivo. Afinal, a biopolítica atual está focada nas crescentes capacidades de controlar, administrar, projetar e remodelar as próprias capacidades vitais. E como fazer isso? A mídia, com as suas convocações, ensina. Busca-se também investigar, por meio da teoria corpomídia, as mudanças no corpo imerso nesse ambiente cesarista, que passar por mudanças cognitivas e provoca outras tantas nesse ambiente

Cesarean delivery is one of the most frequently performed surgical procedures in the United States with 1 in 3 women giving birth by cesarean section. Nurses play a significant role during the labor and delivery process; yet in a hospital in west Texas, nurses lacked knowledge of the current evidence-based obstetric guidelines that were developed to reduce the primary cesarean delivery rates and associated complications. The purpose of this project was to evaluate the content of educational materials developed to inform obstetrical nurses and midwives about labor support strategies to avoid cesarean delivery. Guided by Knowles's whole-part-whole model, a presentation was developed that included evidence-based guidelines and labor-support strategies for positioning and pain management to decrease the choice of cesarean section when not indicated. A 9-member panel with at least 5 years obstetrical expertise evaluated the materials. Based on a descriptive analysis of questionnaire data, experts had a 100% level of agreement that while the educational program material had the potential to promote nursing care practices that would decrease the number of primary cesarean deliveries, changing clinical delivery practices would likely be met with staff resistance. An evidence-based educational program with preventive strategies to decrease primary cesarean deliveries might produce positive social change by prompting obstetric teams to choose these preferred alternatives to avoid to cesarean delivery, and subsequently, decrease associated complication rates, promote faster maternal recovery after childbirth, and decrease the financial burden on the health care system.

This research examined two interrelated issues relevant to maternal and neonatal health in Pakistan, namely, the rising rates of C-section delivery and low rates of exclusive breastfeeding. By using the Andersen's health behavioral model to frame two empirical studies, the data from the Pakistan Demographic and Health Survey (PDHS) 2012-13 was used. The first empirical study examined the correlation between place of delivery and the odds of cesarean section in Pakistan. Not all Pakistani women have an equal chance of delivering at a health facility where C-section delivery takes place; therefore, the study modeled mode of delivery as a two-step process. In the first step, place of delivery was a function of medical indications and various sociodemographic and community factors. Women who delivered at a health facility were included in the second step, where C-section was a function of medical indications and type of facility (private, public). It is found that women who delivered at a private health facility were more likely to have a C-section, even after controlling for the effects of medical/clinical factors, which is concerning. Findings suggest that the private maternal health sector in Pakistan may be over-medicalizing childbirth. The second study examined this paradox of low exclusive breastfeeding in Pakistan, taking into account not only individual-level characteristics of the child and parents, but also place and mode of delivery, sociocultural factors, and community composition. The sample consisted of 1,044 children 0-5 months old, currently living with their mothers. Binary logistic regressions of exclusive and predominant breastfeeding found women who delivered vaginally, whether at home or health care facility were more likely than mothers who delivered via C-section to predominantly breastfeed their infant, and that mothers who delivered vaginally at a health care facility were more likely than their peers who delivered via C-section to exclusively breastfeed their infants. Collectively, the findings of both empirical studies suggest that private maternal health care services in Pakistan may be facilitating medically unnecessary C-sections, either for profit making or time management. An extended and integrated policy regarding medically unnecessary C-section delivery and low rates of exclusive breastfeeding is needed in Pakistan to address both issues together effectively.

No description available.

This is an exploratory study of women’s childbearing decisions and outcomes in non-medically indicated cesarean section childbirths (CS). Focusing on the structure-agency dichotomy, the research is guided by Anthony Giddens’ theory of structuration used in the context of the medicalization framework in order to analyze elements of personal choice and medical jurisdiction in childbearing methods. Quantitative analysis of secondary data and a thematic content analysis of Internet forums are conducted in order to analyze women’s perceptions of autonomy and constraint in their childbearing decisions and outcomes. The findings suggest that the polarization between second- and third wave feminist critiques on medical intervention in childbirth, and between structure and agency, impede our understanding of the complex phenomenon. Applying structuration theory to the medicalization framework helps to work through this polarization, further lending support to third-way feminism.

Objetivo: Avaliar o perfil de citocinas pró-inflamatórias e de melatonina no cordão umbilical e no sangue materno de gestantes hígidas de acordo com a via de parto. Métodos: Entre março e setembro de 2010, foi realizado estudo observacional prospectivo no Hospital Universitário da Universidade de São Paulo. Foram dosadas citocinas (IL-1, IL-6, TNF) e melatonina em pacientes sem doenças clínicas ou complicações obstétricas que entraram em trabalho de parto espontâneo. As concentrações de citocinas e de melatonina foram comparadas de acordo com a via de parto, além do período do dia e do local de coleta. O sangue retirado da veia do cordão umbilical (VCU) era obtido imediatamente após o parto, sendo que após uma hora era colhido o sangue da veia braquial materna (VB). Foram excluídas pacientes com infecção, parto prematuro e sofrimento fetal. Resultados: Foram estudadas 50 parturientes, das quais 25 evoluíram para parto vaginal e 25 para cesárea. A idade materna foi em média 26,0 ± 6,7 anos. A idade gestacional no parto foi em média 39,5 ± 1,7 semanas. O peso médio dos recém-nascidos foi 3366,5 ± 340,2 gramas. Todos os casos receberam analgesia durante o parto (analgesia combinada: peridural e raquianestesia). A maioria das pacientes era de nulíparas (31/50 - 62,0%). A duração do trabalho de parto foi semelhante nas pacientes que evoluíram para o parto vaginal (7,6 ± 4,4 horas) e nas que foram submetidas à operação cesariana (8,2 ± 4,4 horas; p=0,87). Houve tendência de níveis mais elevados de melatonina no VCU e na VB em pacientes após parto vaginal, porém sem diferença estatística (p=0,41 e p=0,16). Pacientes que evoluíram para cesariana apresentaram dosagens significativamente maiores de TNF na VB, de IL-1 na VCU e na VB e de IL-6 na VCU que em pacientes que evoluíram para parto vaginal (p= 0,02; p<0,01; p<0,01 e p<0,01; respectivamente). Observou-se variação no ritmo circadiano das dosagens dessas citocinas após cesariana, com correlação significativa entre dosagem de melatonina e de citocinas nessa via de parto. Conclusão: Pacientes submetidas à operação cesariana apresentaram tendência a redução da secreção de melatonina, com aumento significativo da secreção de citocinas pró-inflamatórias, o que pode ser conseqüência do processo inflamatório relacionado ao estresse cirúrgico / Objetive: To evaluate the profile of pro-inflammatory cytokines and the melatonin level in maternal and umbilical cord blood samples in accordance with the mode of delivery. Methods: Between March 2010 and September 2010, a prospective observational study was conducted at University Hospital of University of São Paulo. Cytokines (IL-1, IL-6, TNF) and melatonin levels were analyzed from maternal brachial vein (BV) and umbilical cord vein (UCV) obtained from healthy patients that started spontaneous labor. The levels of cytokines and melatonin were evaluated in accordance to the mode of delivery as well as the day period and the local of blood sample (UCV - immediately after delivery and BV - one hour after delivery). Patients with infection, preterm labor and fetal distress were excluded. Results: A total of 50 patients were evaluated in the present study: 25 underwent vaginal delivery and 25 c-section. Mean maternal age was 26.0 ± 6.7 years. Mean gestational age at delivery was 39.5 ± 1.7 weeks. The average of newborn weight was 3366.5 ± 340.2 grams. All patients had combined epidural and raquianesthesia. The majority of the patients was nullipara (31/50 62.0%). The labor duration was similar in patients that underwent vaginal delivery (7.6 ± 4.4 hours) or c-section (8.2 ± 4.4 hours, p=0.87). There was a tendency of increased levels of melatonin in the UCV and BV samples after vaginal deliveries, but with statistical significance (p=0.41 and p=0.16). Patients that underwent c-section had increased levels of TNF at the BV, IL-1 at the UCV and BV and IL-6 at the UCV than in patients that underwent vaginal delivery (p= 0.02; p<0.01; p<0.01 and p<0.01; respectively). Circadian variations of the cytokines and the melatonin levels were observed in patients that underwent c-section, with significant correlation between the levels of cytokines and melatonin. Conclusion: Patients that underwent c-section had a tendency of reduced melatonin level, with significant increase in the cytokine levels, which may be consequent of the inflammatory process related to the surgical stress.